Chest
Occupational and Environmental Lung DiseaseOutcome of Occupational Asthma in Patients With Continuous Exposure: A 3-Year Longitudinal Study During Pharmacologic Treatment
Section snippets
Subjects
Twenty consecutive subjects with OA (18 men) from inpatients and outpatients referred to the Institute of Occupational Medicine, University of Perugia, Italy, were asked to participate in this study, and all agreed.
OA was diagnosed in all on the basis of a specific bronchoprovocation test result (in 13 subjects) or peak expiratory flow (PEF) monitoring during and after usual work activity (in 7 subjects).1 Asthmatic reaction after specific exposure was immediate in 6 cases (30.0%), delayed in
Results
Table 1 shows the characteristics, lung function values, PEF variability, PD20, symptom scores, and use of rescue salbutamol at baseline or run-in in the 10 subjects who were followed up for 3 years in their workplace and the 10 subjects who were not. The latter 10 subjects (8 men), left their workplace (6 subjects in the first year, and 4 subjects in the second year). Reasons were reaching the age of retirement (six subjects) and change of job (four subjects, one of whom was made redundant).
Discussion
This prospective 3-year study shows that regular treatment with inhaled corticosteroids and long-acting bronchodilators prevented respiratory deterioration in 10 subjects with OA who were persistently exposed at work to the environmental cause of their disease. In fact, no significant changes in lung function, symptom score, PEF variability, or bronchial hyperresponsiveness were found.
A limitation of this study is the small number of subjects; however, it concurs with recent results of a 1-year
ACKNOWLEDGMENT
We thank Dr. G. A. Boyd for help in reviewing this article, and Stefania Rometta for secretarial assistance.
References (23)
- et al.
Clinical features and natural history of occupational asthma due to Western red cedar (Thuja plicata)
Am J Med
(1982) - et al.
Follow-up of occupational asthma caused by crab and various agents
J Allergy Clin Immunol
(1985) - et al.
Occupational asthma due to various agents: absence of clinical and functional improvement at an interval of four or more years after cessation of exposure
Chest
(1989) - et al.
Consequences of occupational asthma
Respir Med
(1989) - et al.
Clinical and socioeconomic features of subjects with red cedar asthma: a follow-up study
Chest
(1993) - et al.
Occupational asthma: a longitudinal study on the clinical and socioeconomic outcome after diagnosis
Chest
(1999) Management of occupational asthma
Eur Respir J
(1994)- et al.
Prognosis of occupational asthma
Eur Respir J
(1994) Fate of occupational asthma and follow-up study of patients with occupational asthma due to Western red cedar (Thuja plicata)
Am Rev Respir Dis
(1977)
Occupational asthma in electronic workers caused by colophony fumes: follow-up of affected workers
Thorax
Cited by (34)
Bronchial Reactivity and Lung Function After World Trade Center Exposure
2016, ChestCitation Excerpt :Occupational airway disease is heterogeneous, including: work-exacerbated asthma (in those with preexisting asthma)27; occupational asthma, which may be immunologic (characterized by a latent period), or irritant-induced27-29; reactive airway dysfunction syndrome (RADS), an acute form of irritant asthma usually associated with single, high-level exposures28,30,31; and occupational COPD.31,32 Prognosis is variable,28 although a substantial fraction of those with occupational asthma may improve after discontinuation of exposure,17-20 or with inhaled corticosteroid therapy, even without discontinuation of exposure.29 Persons with RADS may or may not improve,18,20,30 whereas those with occupational COPD typically do not improve.32
Empowering employers in work-related injuries prevention: A pragmatic trial
2015, Safety ScienceCitation Excerpt :Studies investigating the effectiveness of prevention programs are nonetheless quite scarce. While there is increasing attention by Public Health Services in Italy regarding workplace safety (Arduini and Della Foglia, 1992; Bavazzano et al., 1993; Baldasseroni, 1994; dell’Omo et al., 1998; Gobba et al., 2000; Marabini et al., 2003; Mancini et al., 2005), the few studies that have been published on this topic are not characterized by a high methodological quality (Mattioli et al., 2009). Both experimental and observational studies assessing work-related injury prevention are under investigation and none of the limited number of trials focusing on educational intervention initiatives (Johnston et al., 1994; Burke et al., 2006) were performed using a randomized controlled trial (RCT) design or assessing occupational injury occurrence as their primary outcome.
Evolution of occupational asthma: Does cessation of exposure really improve prognosis?
2014, Respiratory MedicineCitation Excerpt :The results of these systematic reviews indicate that the available data on the prognosis of OA are insufficient to enable physicians to provide confident, informed advice to patients with the disease. Probably this conclusion is reached because the majority of the more than 100 papers published so far are heterogeneous single-center studies, with small patient samples and based on a single causative agent; all apply an observational approach and, for ethical reasons, none have randomized patients to avoid or continue exposure to the causative agent [15,16]. The aim of the present study is to assess the evolution of all patients diagnosed with OA in the last ten years at two centers in our country according to the persistence or cessation of exposure to the causative agent and, on the basis of the GINA classification, of asthma severity [17].
Work-Related Asthma: A Case-Based Approach to Management
2011, Immunology and Allergy Clinics of North AmericaCitation Excerpt :The medical literature is inconsistent regarding the long-term outcomes of continued but reduced exposure to HMW allergens in workers with HMW OA compared with LMW OA, in which continued exposure usually leads to worsened disease. One small study following 10 workers with OA who were treated for asthma and remained in exposure showed no significant differences in lung function, use of rescue bronchodilator, or respiratory symptom scores over 3 years.16 Two separate studies found similarly good outcomes in workers sensitized to natural rubber latex who were removed from exposure and those who remained in their jobs but greatly reduced their latex exposure through switching to nonlatex gloves while coworkers changed to low-protein powder-free latex gloves.17,18
The diagnosis and management of occupational asthma
2008, Revue des Maladies RespiratoiresMaking the Diagnosis of Occupational Asthma: When to Suspect It and What to Do
2008, Primary Care - Clinics in Office PracticeCitation Excerpt :The pharmacologic management of occupational asthma is identical to nonoccupational asthma [44]. Treatment with inhaled corticosteroids, while attempting to keep the worker in his or her job, can stabilize disease in some patients [45,46]. In this case, close follow-up and frequent monitoring of patient lung function is mandatory.
Financial support was provided by ISPESL.